• Grégoire Le Gal, Michael J Kovacs, Laurent Bertoletti, Francis Couturaud, Carole Dennie, Andrew M Hirsch, Menno V Huisman, Frederikus A Klok, Noémie Kraaijpoel, Ranjeeta Mallick, Amanda Pecarskie, Elena Pena, Penny Phillips, Isabelle Pichon, Tim Ramsay, Marc Righini, Marc A Rodger, Pierre-Marie Roy, Olivier Sanchez, Jeannot Schmidt, Sam Schulman, Sudeep Shivakumar, Albert Trinh-Duc, Rachel Verdet, Ulric Vinsonneau, Philip Wells, Cynthia Wu, Erik Yeo, Marc Carrier, and SSPE Investigators.
• Centre d'Investigation Clinique, Centre Hospitalier Régional et Universitaire de Brest, Brest, France, and Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (G.L.).
• Ann. Intern. Med. 2022 Jan 1; 175 (1): 29-35.

BackgroundThe incidence of pulmonary embolism has been increasing, but its case-fatality rate is decreasing, suggesting a lesser severity of illness. The clinical importance of patients with pulmonary embolism isolated to the subsegmental vessels is unknown.ObjectiveTo determine the rate of recurrent venous thromboembolism in patients with subsegmental pulmonary embolism managed without anticoagulation.DesignMulticenter prospective cohort study. (ClinicalTrials.gov: NCT01455818).SettingEighteen sites between February 2011 and February 2021.PatientsPatients with isolated subsegmental pulmonary embolism.InterventionAt diagnosis, patients underwent bilateral lower-extremity venous ultrasonography, which was repeated 1 week later if results were negative. Patients without deep venous thrombosis did not receive anticoagulant therapy.MeasurementsThe primary outcome was recurrent venous thromboembolism during the 90-day follow-up period.ResultsRecruitment was stopped prematurely because the predefined stopping rule was met after 292 of a projected 300 patients were enrolled. Of the 266 patients included in the primary analysis, the primary outcome occurred in 8 patients, for a cumulative incidence of 3.1% (95% CI, 1.6% to 6.1%) over the 90-day follow-up. The incidence of recurrent venous thromboembolism was 2.1% (CI, 0.8% to 5.5%) and 5.7% (CI, 2.2% to 14.4%) over the 90-day follow-up in patients with single and multiple isolated subsegmental pulmonary embolism, respectively. No patients had a fatal recurrent pulmonary embolism.LimitationThe study was restricted to patients with low-risk subsegmental pulmonary embolism.ConclusionOverall, patients with subsegmental pulmonary embolism who did not have proximal deep venous thrombosis had a higher-than-expected rate of recurrent venous thromboembolism.Primary Funding SourceHeart and Stroke Foundation of Canada and French Ministry of Health Programme Hospitalier de Recherche Clinique.

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